Derosa G, D'Angelo A, Ragonesi P D, Ciccarelli L, Piccinni M N, Pricolo F, Salvadeo S A T, Montagna L, Gravina A, Ferrari I, Paniga S, Cicero A F G
Department of Internal Medicine and Therapeutics, University of Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy.
Intern Med J. 2007 Feb;37(2):79-86. doi: 10.1111/j.1445-5994.2007.01238.x.
Metformin is considered the gold standard for type 2 diabetes treatment as monotherapy and in combination with sulphonylureas and insulin, whereas the combination of metformin with thiazolidinediones is relatively less studied. The aim of the present study was to assess the differential effect on glycaemic metabolism and lipid variables of the combination of metformin plus pioglitazone or metformin plus rosiglitazone in diabetic patients with metabolic syndrome.
All patients began metformin and were randomized to receive pioglitazone or rosiglitazone for 12 months. We assessed body mass index, glycated haemoglobin, fasting plasma glucose, postprandial plasma glucose, fasting plasma insulin, postprandial plasma insulin, homeostasis model assessment index, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoprotein A-I, and apolipoprotein B.
Significant decreases in glycated haemoglobin, fasting plasma glucose, postprandial plasma glucose, fasting plasma insulin, and postprandial plasma insulin were seen after 9 and 12 months in both groups. Homeostasis model assessment index improved at 12 months in both groups. Significant total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoprotein A-I, and apolipoprotein B improvement was observed in pioglitazone group after 12 months, but not in the rosiglitazone group. These variations were significant between groups.
The combination of metformin plus thiazolidinediones was able to improve glycaemic control compared with previous therapy. Pioglitazone was associated with a significant improvement in lipid and lipoprotein variables.
二甲双胍被认为是2型糖尿病单药治疗以及与磺脲类药物和胰岛素联合治疗的金标准，而二甲双胍与噻唑烷二酮类药物联合使用的研究相对较少。本研究的目的是评估二甲双胍加吡格列酮或二甲双胍加罗格列酮联合用药对代谢综合征糖尿病患者血糖代谢和血脂变量的不同影响。
所有患者均开始服用二甲双胍，并随机分为接受吡格列酮或罗格列酮治疗12个月。我们评估了体重指数、糖化血红蛋白、空腹血糖、餐后血糖、空腹血浆胰岛素、餐后血浆胰岛素、稳态模型评估指数、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、载脂蛋白A-I和载脂蛋白B。
两组在9个月和12个月后糖化血红蛋白、空腹血糖、餐后血糖、空腹血浆胰岛素和餐后血浆胰岛素均显著下降。两组在12个月时稳态模型评估指数均有所改善。12个月后，吡格列酮组总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、载脂蛋白A-I和载脂蛋白B有显著改善，而罗格列酮组无改善。两组间这些差异具有显著性。
与先前治疗相比，二甲双胍加噻唑烷二酮类药物联合用药能够改善血糖控制。吡格列酮与脂质和脂蛋白变量的显著改善有关。
